00023103 (SPIN)PERMIT APPLICATION
County of Riverside
Department of Building and Safety
408()Aemonl. 2nd Floor 135 N. Alessandro Rd. Rm. 203 880 N. Stale Street
227 North D" Street 46.209 Oasis St. Rm. 310 160 N. BrGagway,
Fli,eislao., C4192501 Banning, CA 92220 Hemet. CA 92343
Perris. CA 92370 Indio. CA 92201 Blythe. CA St225
'657-3898
Ph: 787-151�4 Ph: 849.7312 Ph: 658.4464
Ph: Ph: 3428271 Ph: 922.2670
This permit becomes void it work nor commenced within 180 days from date of issuance. OR. it work has beer suspended or abandoned for a period Of 180 days.
LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commenc-
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This Section need not be com-'
pleted if the permit is for one hundred ($100) or less. I certify that in the performance of the work for wl ch this
inSection 7000) of Division Sof the Business and Professions Code, and my license is in full force and effect.
permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Corr pensa-
%g-with
lion Laws of California.
Fl -
Date Applicant
• OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the
NOTICE TO APPLICANT: It, after makingthis Certificate of Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code. you must lorlhwith comply with such provisions or this permit :hall be
following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permi to con-
deemed revoked.
struct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant or such
s permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License 6w
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is ex -
ii empt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a per-
01 hereby certify that no excavation live (5) or more feet in depth into which a person is required to clesce III. will
�nit subjects the applicant to a civil penalty of not more than live hunderd dollars ($500).):
be made in connection with work authorized by this permit, and that no building Sirjclure. scaffolding, la.lawork,
1,
or demolition or dismantling thereof. will be more than thirty-six (36) feet high. (Chap. 1-2. Grp 2. Art 2. SFc 341,
Title 8. C.A.C.).
as owner of the property, or my employees with wages as their sore compensation, will do the work, and the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractor's License
Cl As owner -builder. I will not employ anyone to do work which would require a permit from the Divisior of In- -
Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or
through his own employees, provided that such improvements are not intended or offered for sale. If, however.dusIrial
Safety. as noted above. unless such person has a permit to do such work from the division.
the.building or improvement is sold within one year of completion, the owner -builder will have the burden of prov
[]Division of industrial Safety Permit No.
rig that he did not build or improve for the purpose of sale.)
01, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the oerlor-
7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who
mance of the work for which this permit is issued (Sec. 3097, Civ. C.).
builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Con-
Lender's Name
iN. tractor's License Law.)
Lender's Address
I am exempt under Sec. B.& P.C. (Attach Certificate).
Date Owner
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and state
that the information given is correct. I agree to comply with all state laws and county ordinances relating to
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consentto sell -insure, insure. or a
building construction, and authorize a representative of the County of Riverside, Department 91 Building and!Safely
Certificate of Workers' Compensation Insurance. or a certified copy thereof (Sec. 3800. Lab. C
I
to enter uf�qn the properly for which I have applied for this permit for the purpose of making inspections.
E)Certified copy is hereby fu mished.
A;-
'
Ocertified copy is filed with the County Building Inspection Department or County Department.
Signature of Applicant or Agent Date
TASPE C -:TOR
FORM 284208 (1181(,
Print Applicant/Agent Name
V OW41 10 y. PQ 0(3/0r,-�D,08?
"'PECT
TOTAL
FEE
CA I CKA NC COUNTER B.I. COUNTER L.U.T.
176
3 F C 1 A L.. I IN P E C . T I - 1) N P F.
TOTAL. PERMIT COST IS $30.00
'C'
W.- W 101-601iffies I
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace
P. L.
43
Final _ Z
IDA
Fireplace
T. 0.
P'
ADDITIONAL INFORMATION
Y
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Loth
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Batts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
P/L
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
P/
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
298 Bonding
30 Fixtures
31 Service
32 Final . -g L
STREET NAME
TO:
SUBJECT:
REFERENCE
REQUEST FOR CERTIFICATION
Local governing authority
County of Riverside
Request for certification of acceptability of property under applicable
local building code(s). e�
Location of dwelling: J L.:!:)` V `r P
community: OLA t —
I hereby request an inspection of -the above located dwelling for a determination of the
following, as well as a Certification of Acceptability (or Nonacceptability as the situation
wa/rrants)i
(1O1. Compliance with local building codels) applicable to the existing dwelling.
El 2. Compliance with applicable local code(s) on room.addition.
D 3. Compliance with applicable local c'ode(s) on. garage conversion.
0 4. Compliance with applicable local code(s) on sewage disposal system.
❑ 5. Compliance with Tplicabl local co�f (s on others ecial construction.
(describe) %7 "Y
Signed: ^
Zer./Agent/)T
Address: �/ ✓ �' 4 L jE O
`1�. S 5
Zip.
284-49 8/76
�• CERTIFICATE OF ACCEPTABILITYMONACCEPTABILITY
L
Owner:
` Date of Inspection
Location of Dwelling: 5 3 mss? )1 11 G" 0
// Building Permit. No.
Community:
r _
I certify that as a part of my official duties as building inspector, 1 have on the date indicated,
inspected .the above.located dwelling as requested, and have noted the following violationls) of
theappy ble building code(s):
i
None. There is no violation ofthe applicable building code(s).
Reinspection/
N' 'P
❑ The following nonacceptable conditions exist:
El Sanitary inadequacy:
' I
El Structural hazard:
❑ Hazardous wiring:
El Hazardous plumbing:
❑ Faulty weather protection:
❑ Fire hazard:
El Faulty' materials of construction:
❑ Additional details are noted on reverse side of this form.
Remarks:
❑ Conforms to other applicable ordinances.
❑.I further certify that a record is available.indicating'proper completion:
ew ermt
Required
(Building Permit No.) (C6fripletion Date)
❑'The building permit completion 'record is not available. H'ecords indicate age of this structure
has led to destruction of h
• completion record.',
There is n re rd avail ble
of the construction involved. However, th nstruction appears
Date
County of Riverside
Request for certification of acceptability of property under applicable
local building code(s). e�
Location of dwelling: J L.:!:)` V `r P
community: OLA t —
I hereby request an inspection of -the above located dwelling for a determination of the
following, as well as a Certification of Acceptability (or Nonacceptability as the situation
wa/rrants)i
(1O1. Compliance with local building codels) applicable to the existing dwelling.
El 2. Compliance with applicable local code(s) on room.addition.
D 3. Compliance with applicable local c'ode(s) on. garage conversion.
0 4. Compliance with applicable local code(s) on sewage disposal system.
❑ 5. Compliance with Tplicabl local co�f (s on others ecial construction.
(describe) %7 "Y
Signed: ^
Zer./Agent/)T
Address: �/ ✓ �' 4 L jE O
`1�. S 5
Zip.
284-49 8/76
�• CERTIFICATE OF ACCEPTABILITYMONACCEPTABILITY
L
Owner:
` Date of Inspection
Location of Dwelling: 5 3 mss? )1 11 G" 0
// Building Permit. No.
Community:
r _
I certify that as a part of my official duties as building inspector, 1 have on the date indicated,
inspected .the above.located dwelling as requested, and have noted the following violationls) of
theappy ble building code(s):
i
None. There is no violation ofthe applicable building code(s).
Reinspection/
N' 'P
❑ The following nonacceptable conditions exist:
El Sanitary inadequacy:
' I
El Structural hazard:
❑ Hazardous wiring:
El Hazardous plumbing:
❑ Faulty weather protection:
❑ Fire hazard:
El Faulty' materials of construction:
❑ Additional details are noted on reverse side of this form.
Remarks:
❑ Conforms to other applicable ordinances.
❑.I further certify that a record is available.indicating'proper completion:
ew ermt
Required
(Building Permit No.) (C6fripletion Date)
❑'The building permit completion 'record is not available. H'ecords indicate age of this structure
has led to destruction of h
• completion record.',
There is n re rd avail ble
of the construction involved. However, th nstruction appears
to meet c e.
Signed
( yped or Printed Na ie of
wilding liupector)�
,County of Riverside
vitt
D�.�n'�
ate of Certificate
CP% t 3TTIU M ON., ..$SAVllgQS
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VIM u u u
1
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ss
.,9 E ,Rl I .t UC4g' .i, ai
.PHONE.#
CONTRACTOR -FIRM NAME
LICNC #
ADDRESS ..
CITYICOMMUNITYISTATEIZIP '
PHONE N. BLDG.INSPECTOR
FINAL DATE
ARCIENG FIRM NAME -
A
LICNC p
ADDRESS
. CITYICOMMUNITY/STATE/ZIP
PLAN .# - PLANS
EXAMINER
APPROVE DATE
' . _TIZbN
FSB
y4611j,
V, Yj
' ZONE ORD #
LOT SZ
END
ul SID
VWORET3 10 til 6AQ O aY o �pATU L11 L.3 V W 1 7-1
y,.
I
k '
TOTAL
FEE
CA CK NC COUNTER B.I. COUNTER L.U.T. -
ORl.ICAtXCJi+t' FCA SPECIAL XPdSKCTION
.wL '
r N 1 4 !` x F� A N A P t'' . L I C A -:1` x 0 N C) N -L v
mist ��
t
mist ��
NO.
OPERATION DATE
INSPECTOR
NO.
OPERATION
DATE INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
1
Set Back
33
Ventilation System
2
Ftgs 8 Frms
34
Plenums 8 Ducts
2A
Slab Grade
35
Furnace Comport.
3
Steel
36
Inlets 8 Outlets
4
Grout Blocks
37
Combustion Air
5
Bond Beams
38
Compressor
6
Roof Deck
39
Appl. Clearance
7
Framing
40
Fire Damper
8
Vents
41
Smoke Detection Device
9
Garage Fire Wall
42
Commercial Hood
10
Fireplace P. L. ❑
43
Final
IDA
Fireplace T. 0. E]
No
ADDITIONAL INFORMATION
SEWAGE SYSTEM SIZE & LOCATION
11 Exterior Lath
12 Internal Lath
12A Drywall
13 Finish Grade
INSULATION Thick R
Value
7A Walls (Botts)
12B Ceiling (Batts)
12C Ceiling (Blown)
14 Final
PLUMBING APPROVALS
15 Ground Plumb —
16 Water Piping
17 Rough Plumb
18 Vents
19 Sewage Disposal
20 Sewer
21 Water Heater
22 Water Softener
23 Water Service
24 Gas Test
25
Final
Tank Pit L.Line
REAR OF PROPERTY LINE
ELECTRICAL APPROVALS
PSL
PSI
26 Power Pole
27 Conduit
28 Service Entrance
29 Wiring
29A Grounding Wire
29B Bonding
30 Fixtures
31 Service
32 Final
STREET NAME